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Earning Trust

For many who have lived with the effects of intense stress or trauma, trust does not come easily, and in some cases it may not come at all.  Clinicians in the SUD, trauma, and mental health fields are well used to the challenges involved in the process of building trust.  For veterans with post-deployment stress effects, with the amygdala always ready to pull up savage bursts of memory and ignite surges of stress chemicals, mistrust may be one of the healthiest and most reasonable protective impulses.


High Alert:  Many veterans who have served in Iraq and Afghanistan have spent months or years hyper-aware and on high alert.  Those who also grew up in homes where substance use disorders or other challenges created “sub-currents” in the family system may have been on alert long before their military service began.  Many veterans’ radar is acutely sensitive, so they will miss nothing.  And you might not be trusted until you earn their trust.

When some veterans walk into your office, you might perceive an attitude of polite, emotionally controlled wariness.  This is not just a reflection of the disciplined military culture and the aftermath of war.  It is also a very rational attitude in the midst of a civilian culture that often has little understanding of the Service Member’s experience and sometimes says things that are well meant but insensitive (e.g., “Too bad the war was all for nothing,” or “Did you kill anyone?”).

According to more than one veteran interviewed for these pages, if you are going to be working with returning veterans who have post-deployment stress effects, you may well be tested.  According to one veteran interviewed, clients may begin by saying a few things designed to evoke extreme responses, so they can test your personality, approach, and types of responses.  They might tell you stories—accurate or inaccurate—about episodes of extreme violence or “abnormal” reactions in the war zone, and then watch your reactions. 

In a sense, this testing process may be an important way for veterans to establish safety:  Alison Lighthall (2008) spoke of a Service Member who had poured out his litany of traumatic war experiences to a civilian counselor for a full session.  At the end, the counselor had told him, “I still can’t get my head around the fact that you kill people for a living.”  The young man experienced considerable trauma and betrayal from this exchange, and a significant setback in his recovery followed that incident.

What is most disturbing is that, if a veteran’s first fledgling attempt to reach out for help does not result in a positive, empowering, respectful interaction, he or she may never reach out for help again (Lighthall, 2008).


Clinicians’ Own Emotions:  Traumatic material can raise strong feelings in those who hear it, particularly in the empathic people who tend to gravitate to the helping professions.  According to veterans and clinicians interviewed, a number of forces join to make clinicians’ management of their own emotions particularly important—and particularly challenging.  For example:

  • It makes sense for a military culture to see strong shows of emotion as undisciplined and therefore threatening to the well being of the Unit.  Depending on how thoroughly steeped the individual veteran has been in the military culture, a strong show of emotion on the part of the clinician might invoke some feelings of wariness.
  • Some people with post-trauma effects are fighting off a number of triggers for their own powerful emotions, emotions that they would rather not feel.  Strong emotions on the clinician’s part might seem like a threat to their own fragile sense of control.
  • As mentioned in the previous page, Service Members and veterans are very much aware of the stereotypes and stigma that color some civilians’ attitudes toward them.  Veterans interviewed said that a clinician’s expressions of shock or horror will often seem like a judgment of the veteran, and levels of sympathy that seem exaggerated will often seem like condescension.
  • Veterans’ experiences will raise strong emotions in the clinician.  It will not be possible—and would not be healthy, authentic, or appropriate—to absorb the pain without showing emotions.
  • Even veterans who fear or mistrust emotions will need to know that clinicians connect with their experiences on a human level.  Without that connection, veterans are locked in with the trauma—and the stigma—and deprived of the empathic face-to-face communication that draws both the prefrontal cortex and the human spirit into the healing process.

So what does the clinician do?  A cool, clinical “detachment” is nearly impossible, and in War and the Soul Edward Tick confirms that detachment would not be the answer.  “In traditional therapy, the prevalent view is that healing can best occur if the therapist remains emotionally detached from the client's life and material.  In working with vets, though, the opposite is true:  If the therapist maintains detachment, the story remains solely the burden of the patient.  Therapy becomes effective only when the therapist can affirm that he is personally engaged with the veteran’s story and accepts the need to help carry the collective responsibility” (Tick, 2005, p. 238).

According to Lia Gaty, it is essential to tailor responses to the individual veteran.  The key may also be to remember that it is the veteran’s emotions that are the centerpiece of the relationship.  The clinician’s reactions cannot be allowed to distract from the central context that is the client’s experience.  The clinician can and must have and show emotions, because these emotions reflect common human response to human experiences.  These feelings should be genuine, ordinary, matter-of-fact responses to the veteran’s experience (Gaty, 2008b). 

Two words that come to mind are dignity and opennessDignity carries both discipline and balance, and openness challenges the isolation and the stigma.  If you can find that balance between empathy and unconditional acceptance of the person and the experience, you will not only fit in better with the military culture, but also help the amygdala loosen its grip.


Talking to the Amygdala:  Some experts in the field speak of “talking to the amygdala,” saying things that are likely to calm that frightened, defensive structure deep in the brain and persuade it to refrain from triggering strong stress reactions.  But when we are talking to someone affected by trauma, we are always talking to the amygdala.  It is merely a question of whether or not we are saying what we would like to say.

The amygdala is always scanning our words, gestures, faces, and tones of voice for signs of threat—and using a fairly inclusive definition of threat.  Even an expression of anxiety on the face or in the voice of another can trigger the amygdala’s alarm system.  The clinician’s job is to:

  • Learn the language of the amygdala
  • Use it to communicate safety and empowerment
  • Teach the veteran to do the same


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The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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